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City Surcharge
PERMIT APPLICATION: INDAYS
PERMIT &UNIT I YEAR - PROVIDED WORKISISTARYIED.11.114 180MAYS
State Surcharge
SEREACK
IDK OF PINK PEA!LM FOR MORE INFORMATION
'APPILICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, SHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Review
Receipt III
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FR M THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT HALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE
Fire Inspection
Total Amount Due
415
ANY REQUIREMENT OF ANY TY ORDINAN E
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NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION,
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Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I Am THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application Is net a permit until signed by We
TIONi AND IN DOING THE WOR NO PERSON WILL BE EMPLOYED
THOR - 'S-E_bF
Binding 011clalm hismor Dopmly: And Fees are paid, and
IN VIOLATT LABOR"
ON OF THE ':�UcGOfo1HETl.iATE WASHINGTON RELATING TO
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FOR INSPECTION
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771-0220
ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
ORIGINAL - FILE - YELLOW INSPECTOR
10/01
FAX
PINK - OWNER - GOLD � ASSESSOR
F I N A L P W0- XE-C T-A-P PRO V A �LF 0 R M
TO:
DATE: —
I I lEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE-.S 3 --C)
ENGINEERING DIVISION DATE —
PLANNING DIVISION DATE—
PROJECT—CA3nffd'�E"'
SITEADDRESS—� �7-
PERMIT 4,.��.ADB#________pATE INSPECT
DESCRIPTION OF WORK TO BE INSPECTED-5E4-L��
A field inspection was conducted to determine final compliance with approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
pE RMANCE BONDS and the granting of
GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL wrrH CONDITIONS NOTED
0 Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUE S
0 copy of CORRECTION NOTICE given to owner/contractor by inspector
2.
3.
RE GRANT FINAL PROJECT APPROVAL
-INSPECTED OUTSTANDING ISSUES
Date---
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